Executive Summary for Independent Health Case Study on Value-Based Payments

Independent Health Overview

Headquartered in Buffalo, New York, Independent Health is a not-for-profit health plan that began operations in 1980. Serving approximately 375,000 members with a dedicated team of 1,080 associates, the organization continually aims to provide innovative, affordable access to health-related products and services. It offers commercial group products, Medicare and Medicaid plans, and traditional indemnity plans.

Challenge

With the growing acceptance of value-based reimbursements, Independent Health recognized the need to transition from the traditional fee-for-service (FFS) model. This transition was essential for driving down healthcare costs and positively impacting patient outcomes. To achieve this, the organization needed greater alignment with its provider network, particularly among primary care physicians.

Partnership with HealthEdge

Independent Health partnered with HealthEdge, utilizing their HealthRules® Payer platform as its core administration system. This collaboration enabled Independent Health to:

• Rapidly address market opportunities and stay ahead of competition.
• Provide accurate, real-time information to everyone involved in the care continuum.
• Significantly lower administrative costs by automating critical manual business processes.

Key Program Benefits

By leveraging HealthRules® Payer, Independent Health achieved the following:

• Increased sharing of robust, accurate, and transparent data with providers.
• Enhanced web and digital capabilities to improve engagement and member satisfaction.
• Implemented a nimble core administrative platform, critical for agility and flexibility.

Results

Independent Health reports that 98% of primary care practice members are now in full capitation contracts, aligning goals between Independent Health and its providers. This alignment has led to improved patient outcomes, reduced healthcare costs, and increased customer satisfaction.

Significant Milestones:

• Cost Reduction: Targeting approximately 5,000 patient encounters in post-acute settings resulted in a cost reduction of $14.8 million, representing a 10% decrease.
• CMS Initiative: Participation in the second phase of the Centers for Medicare and Medicaid Services' (CMS) Comprehensive Primary Care Plus (CPC+) Initiative aimed at improving care, better population health, and lowering health costs.

Conclusion

Independent Health's collaboration with HealthEdge exemplifies how value-based payments can transform healthcare delivery and reimbursement. The partnership has not only driven efficiency and cost savings but also enhanced overall community health and satisfaction.

For more information on how HealthEdge's solutions can support your organization in navigating value-based payments, visit HealthEdge.